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It is a quote that I have heard often used by Merck scientists, given by CEO George W. Merck in an address to the Medical College of Virginia in 1950.

“We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.” (taken from “Built to Last, James C. Collins and Jerry I. Porras, 1994)

Ironically, this quote is now being used as an example of how the pharmaceutical industry has lost its way, that a pharma company’s focus should be solely on the patient and not on pricing, profits, or selling drugs for unapproved uses. In some ways, George Merck’s quote portrays a simpler time, when drug companies were well thought of and drug sales and profits were accepted. You can almost envision a Norman Rockwell painting depicting a scientist in a lab working diligently to come up with a cure for a disease while a separate panel shows anxious parents in a hospital hovering over their sick child.

Unfortunately, the reputation of the pharmaceutical industry has dropped precipitously since the late 1980s. The culprits in this decline have been corporate types, particularly the sales and marketing folks, who are perceived as relentlessly driving to maximize profits at the expense of the welfare of patients. Furthermore, such actions are blamed for the pharmaceutical industry losing its way resulting in the conversion of what was once one of the world’s most admired industries to one that is likened to tobacco companies.

Regular readers of this blog know of my concern with the reputation of the pharmaceutical industry and my thoughts on how companies can restore their image to not just where it had been but to where it deserves to be based on the great work it does in discovering and developing new, important medicines. But, while his advice was appropriate for is time, I think that George Merck’s advice is not easily applied to the drug industry today.

Six decades ago, a drug could go from the lab bench to the market in just a few years. Back then, there were few medicines to treat most diseases and the safety/efficacy hurdles for a drug’s approval were minimal. An experimental compound could be synthesized then tested in prisoners (with the prospect of time off for good behavior) in a matter of weeks. Such a paradigm is unthinkable now. To go from an idea, to a potential drug candidate and then to the first testing of the compound in humans now takes 3 – 5 years and costs millions of dollars. And that is the “cheap” part. Long term testing in patients for safety, efficacy and differentiation from current standard of care can take another decade and drive the overall program costs to at least a billion dollars. As a result, profits become very important. Without them, a company will soon be out of business.

This, then, is the ultimate issue that pharmaceutical companies face. Yes, “medicine is for the people”. But this is an expensive business and a new medicine doesn’t automatically yield the necessary profits to sustain the business. I have talked previously about the plight of those suffering with diseases not prevalent in Western world populations. This is a difficult situation. But if a pharmaceutical company were to devote itself to these diseases, it would collapse as the drugs would essentially have to be given away for free as these patients cannot afford it.

This is where the Sales & Marketing organization has to come in. For any company to thrive and to bring new medicines to market, a pharmaceutical company must have a close relationship between the R&D organization and the Sales & Marketing group. Communication is a must. Identifying a major medical need is straightforward, e.g., drugs to treat breast cancer, Alzheimer’s disease, resistant bacterial infections, etc. But the ultimate profile of the drug is critical for success. It is the Sales & Marketing division that provides the input for what hurdles the drug must overcome in order to benefit patients, to ensure that physicians will prescribe it and that payers will reimburse the costs of the drug. R&D cannot act in a vacuum. It needs to understand its customer and that is not just the patient but the commercial opportunity. The Sales & Marketing organization supplies that guidance.

In George Merck’s time, an R&D organization acted largely independently without such input. They were able to be successful by producing new drugs and handing them off to the Sales & Marketing division as they were readied for approval. But such a paradigm cannot succeed today. The commercial organization really needs to be intimately involved setting the boundaries of R&D’s efforts. Pharmaceutical company critics decry such interactions, believing that this taints the science and the goals of R&D. but, in reality, it is just good business sense.